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Abstract: FR-PO856

Three Decades of Dialysis Initiation After Kidney Transplant (KT) Failure: Trends in Waitlisting, Retransplantation, and Survival (1988-2018)

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • Khairallah, Pascale, Baylor College of Medicine, Houston, Texas, United States
  • Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
  • Lorenz, Elizabeth C., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States

The number of persons returning to dialysis after KT failure has been increasing; they now constitute the 4th largest group of dialysis starts. Little is known about the trends in mortality, waitlisting, and retransplantation and after KT failure.


From the USRDS we identified patients age ≥18 yrs who received a first KT and experienced KT failure between 1/1/1988 and 12/31/2017. Recipients of other solid organ allografts were excluded. Patients were followed from the time of KT failure date to the outcomes of 1) death, 2) waitlisting, and 3) retransplantation. Patients were censored at end of dialysis record, end of Medicare coverage, or at 5 yrs from time of KT failure. We used multivariable Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) comparing death, and cause-specific hazard model to compare other outcomes across subsequent eras relative to 1988-92.


We studied 100,373 patients with a failed first KT. Of all patients initiating dialysis de novo, the proportion of patients (re)initiating dialysis after allograft failure increased from 2.49% in 1988-92 to 3.94% in 2013-17. The median age at which allografts failed increased from 41 yrs in 1988-92 to 56 yrs in 2013-2017. After adjusting for age, sex, race and ethnicity, and relative to 1988-92: 1) mortality was 10%, 25%, and 34% significantly lower in 2003-07, 2008-12, and 2013-17, respectively; 2) the rates of waitlisting were similar across subsequent eras, but 24% lower in 2013-17 (3.2% of patients were waitlisted preemptively); and 3) the rates of retransplantation were between 13% and 20% lower in later eras (Figure).


While mortality rates of patients with failed allografts have improved over time, rates of waitlisting and retransplantation rates have decreased. Understanding the barriers to retransplantation will be crucial to inform potential future interventions designed to improve access to KT in this growing population.


  • NIDDK Support